Co-creating Care with Ethnic Communities Helen Leung, MSW Chief Executive Officer Carefirst Seniors and Community Services Association Carefirst Family Health Team February 17, 2010
Agenda 1. About Carefirst 2. Demographics of ethnic communities 3. Health challenges: Chronic diseases 4. Chronic disease management programs at Carefirst: Lessons Learned 5. Customizing health education programs: Best Practices
About Carefirst Carefirst s Group of Organizations: Carefirst Seniors and Community Services Association (Since 1976) Carefirst Vocational Training Centre (licensed since November 2009; Opening in 2010) Carefirst Family Health Team (Since 2007) Carefirst Foundation (Since 2006)
About Carefirst: Charity, Non-for-profit Carefirst Seniors Ethno-specific community support service provider for the Chinese community Serves 6,500 clients/year Carefirst Family Health Team Primary health care provider for Ontarians, specifically for Asian communities Serves 5,500 patients/year Serves the Greater Toronto Area and surrounding areas
More about Carefirst Integrated delivery of social and health care services in the community, including: Community support services Homecare and homemaking Social / wellness educational programs Chronic disease prevention and management Volunteer development Community outreach Family Health Team primary health care
Major Ethnic Populations Markham: 17% Richmond Hill: 4% Markham: 34% Richmond Hill: 15% Scarborough: 22% Vaughan: 6% Vaughan: 4% North York: 10% North York: 14% City of Toronto: 12% Scarborough: 20% South Asian Chinese Mississauga: 21% City of Toronto: 11% Mississauga: 7% Source: Census 2006; Toronto Public Health; York-Simcoe DHC for Markham & Richmond Hill statistics
Demographics of ethnic populations Steady growth of visible minority population: From 42.9% (2006) to the projected 50% of the total by 2017 The largest group are: South Asian (India/Pakistan/Sri Lanka) and Chinese (PRC/ Hong Kong SAR/ Vietnam) High concentration of visible minorities residing in suburban areas: (e.g.) 52.4% of Markham s population is visible minorities The senior (>65) population belonging to visible minority groups in Canada is rising: Under 6% in 1996 Over 7% in 2001 Source: (Census, 2001; Census, 2006)
Growth of the Canadian Ethnic Populations In March 2005, Statistics Canada projects: By 2017, more than 50 percent of people living in Canada would be visible ethnic groups (primarily of Asian and South Asian origins). Source: (Census, 2001; Census, 2006; Statistics Canada, 2005)
Profile of Carefirst s Seniors 60% are aged 75 and over 25% are frail and homebound seniors who require more intensive care support services 75% are seniors with low-income (less than $20,000/ year) 98% of seniors speak only Chinese (Cantonese or Mandarin) and no English 6% of seniors have driving licenses
Health Situation of Ethnic Seniors Declining health status: From healthy immigrant to worsened self-reported health in Canada Older immigrant women (Chinese/South Asian) reported worse health Lower utilization of health care/ social services Personal Care Usage: Chinese (1.5%), General elderly population (36.7%) Home Care Usage: Chinese (3.5%), General (7.3%) Challenges in managing their own health Multiple jeopardy situation: being old, immigrant, visible minority, women, etc. Source: (Lai, Tsang, Chappell, Lai, & Chau, 2003; Wayland, 2006; Wong, 2007)
Chronic Diseases in the Ethnic Populations Across Canada, older Chinese have more chronic illnesses (3.3 types) than the general elderly population (2.23 types) In Ontario, 12% of the population with diabetes is of South Asian origin ICES (2005) identified 13 priority neighbourhoods with high rates of diabetes Mostly in the northwest and eastern parts of Toronto High risk communities are: visible minorities, immigrants, and with low income Source: (Hux & Tang, 2003; Glazier & Booth, 2007; Lai, Tsang, Chappell, Lai, & Chau, 2003)
Challenges to better health status Inaccessibility and difficulty in navigating the social services and health care systems Service gaps in linguistically and culturally relevant health care services Under-utilization of health care services by immigrants, despite higher illness incidence Significant cultural differences in utilizing health care services More vulnerable to new emerging global epidemics Poorer socioeconomic status poorer well-being Source: (Ho, 2008; Lai, Tsang, Chappell, Lai, & Chau, 2003)
Chronic Disease Management Programs at Carefirst (1) Four main programs: 1. Diabetes Education Program (Carefirst FHT) Offering inter-disciplinary, linguistically and culturally appropriate, and evidence-based education programs 2. Chronic Disease Self-management Program Structured program developed & licensed by Stanford University Chinese version: General, chronic pain, diabetes
Chronic Disease Management Programs at Carefirst (2) 3. Kidney Health Initiative (Collaboration with Scarborough Renal Dialysis Program & Kidney Foundation of Ontario) 3-year project, early identification of high risk kidney disease Pre-screening, health education, referrals to physicians 4. Diabetes Prevention & Self Management Program Central LHIN-funded initiative, in collaboration with Markham Stouffville Hospital (2010) Pre-screening, health education, referrals to physicians
Practitioners Insights Lower participation by individuals under the age of 70 Challenges perceived by the practitioners: Participants generally have lower level of education Lower level of personal health awareness Lower level of disease awareness (i.e. delayed help seeking) Motivation not as high Displayed inertia during the programs Older participants are dependent on adult children or even grandchildren for transportation, language supports Fear of disobeying the doctors Little support from family members Resistance to diet change: e.g. the Asian diet
Lessons Learned & Best Practices (1) 1. Language, transportation, financial dependence (major obstacles) Language-specific workshops Acknowledge the heterogeneity within the same culture Services within walking distance and at various hours 2. Continuous outreach to target population (passive attitude) Use diverse channels: newsletter, outreach screening clinics, mass media Community education to enhance knowledge and awareness of health and services 3. Involvement of families Mobilize family support, e.g. collective behaviour, eating habits Important to have family members buy in
Lessons Learned & Best Practices (2) 4. Physicians practice beyond the biomedical approach Prescribe health education as part of medication and treatment Emphasize on self-management and lifestyle modification 5. Staff sharing the same cultural-linguistic background as the client Enhance communication, client enthusiasm, reduce power inequity Minimize the teaching mode 6. Education materials need to be user-friendly At appropriate level of literacy Combinations of words and pictures
Lessons Learned & Best Practices (3) More collaboration with other service providers and ethnic community agencies Enhance outreach Train volunteers of different cultures Gain credibility from the clients Share resources and best practices Giving incentives to the participants E.g. TTC tokens, light refreshment, educational materials to take home Stable resources support The supports from funders (e.g. LHINs) are essential for ongoing success
Customizing Health Care & Best Practices Individual Level Work with personal health strategies Intergenerational relations Help-seeking behaviours and self-efficacy Program Level More collaboration between community agencies Community Level Transportation Support for system navigation Reduce socio-cultural-linguistic barriers to health care access
Customizing health care & Best Practices Continuous learning and quality improvement Ongoing training of the program facilitators / volunteers Incorporate current best practices Continuous program evaluation and improvement Recognize impact of settlement process on health
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